Citation

Owens C, Hansford L, Sharkey S, Ford T. Br. J. Psychiatry 2015; 208(3): 286-291.

Affiliation

Christabel Owens, PhD, Lorraine Hansford, MSc, University of Exeter Medical School, Exeter, UK; Siobhan Sharkey, PhD, RMN, Plymouth University Peninsula School of Medicine & Dentistry, Plymouth, UK; Tamsin Ford, PhD, MRCPsych, University of Exeter Medical School, Exeter, UK.

Copyright

(Copyright © 2015, Royal College of Psychiatry)

DOI

10.1192/bjp.bp.113.141242

PMID

26450583

Abstract

BackgroundPresentation at an accident and emergency (A&E) department is a key opportunity to engage with a young person who self-harms. The needs of this vulnerable group and their fears about presenting to healthcare services, including A&E, are poorly understood.AimsTo examine young people's perceptions of A&E treatment following self-harm and their views on what constitutes a positive clinical encounter.

METHODSecondary analysis of qualitative data from an experimental online discussion forum. Threads selected for secondary analysis represent the views of 31 young people aged 16-25 with experience of self-harm.

RESULTSParticipants reported avoiding A&E whenever possible, based on their own and others' previous poor experiences. When forced to seek emergency care, they did so with feelings of shame and unworthiness. These feelings were reinforced when they received what they perceived as punitive treatment from A&E staff, perpetuating a cycle of shame, avoidance and further self-harm. Positive encounters were those in which they received 'treatment as usual', i.e. non-discriminatory care, delivered with kindness, which had the potential to challenge negative self-evaluation and break the cycle.

CONCLUSIONSThe clinical needs of young people who self-harm continue to demand urgent attention. Further hypothesis testing and trials of different models of care delivery for this vulnerable group are warranted.

Language: en